Family Health History Questionnaire

The Family Health History Questionnaire can be used to know any history of diseases in the family of a patient. It collects the vital information like name, number, date of birth along with previous illness or family illness.

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Understanding the Family Health History Questionnaire

Before offering care to a patient or even diagnosing them, doctors need to be aware of their medical history and if there has been any history of family illness. The Family Health History Questionnaire helps you gather crucial information and deliver better care.

The Family Health History Questionnaire can help you collect the information you diagnose your patient, deliver care, or even maintain data. To try the Family Health History Questionnaire, sign in or sign up with Zonka Feedback.

4 Questions

6Screens

1 min to complete

List of Family Health History Questions

The following questions are included in this Family Health History Questionnaire.

Before we get started, what's your name?
And could you tell us your date of birth?
Have you ever suffered from any of the following illnesses?
Please leave your phone number in case we need to follow up with you

Sign Up or Sign In on Zonka Feedback for free and try this Family Health History Questionnaire to evaluate patient data and their family health history.

Create and send this Family Health History Questionnaire